A surgical modification for performing orbitozygomatic osteotomies: technical note

The addition of orbitozygomatic osteotomies to the fronto-temporo-sphenoidal craniotomy minimizes brain retraction required to reach deep seated pathology by allowing additional soft tissue dissection and strategic cranial bone removal. We report a modification of this technique in order to reduce soft tissue and cosmetic morbidity while increasing the efficiency with which this technique is performed. A two piece fronto-temporo-sphenoidal craniotomy combined with orbitozygomatic osteotomies was analyzed via cadaver dissection. The craniotomy and orbitozygomatic osteotomies were performed using the foot plate of the craniotome to facilitate the orbitozygomatic osteotomies. A similar technique was utilized in the operating room to safely create the two piece fronto-temporo-sphenoidal craniotomy and orbitozygomatic osteotomies in a series of patients. The illustrated technique was performed in cadavers and the results were analyzed in a series of 18 consecutive patients with minimum 3-month follow-up. Increased efficiency, good tissue preservation, and minimal soft tissue damage with no orbital injury were noted with a high rate of gross total lesional resection. With the added safety of a cutting instrument separated from the orbital soft tissues by a footplate, tissue trauma was minimized. Orbitozygomatic osteotomies are frequently added to the fronto-temporo-sphenoidal craniotomy in order to reach intracranial pathology that would previously have required excessive brain retraction to address. This manuscript details the use of a single drill system that can be used for both the craniotomy and the safe and efficient generation of orbitozygomatic osteotomies.